Internal Medicine

     

    Chronic Fatigue Syndrome (CFS)

    • Defined:
      • Chronic Fatigue Syndrome (CFS) Definition

        • Medical unexplained fatigue
        • ≥ 6mo
        • ≥4 of following:
          • Subjective memory impairment
          • Tender lymph nodes
          • Muscle or joint pains
          • Headache
          • Unrefreshing sleep
          • Postexertional malaise lasting > 24hrs.

     

    Approach to Local Edema

    • Inflammation/Infection
    • Venous Obstruction
      • Thrombophlebitis/DVT
      • Venous insufficiency
    • Lymphatic Obstruction
      • Lymphatic Tumor Infiltration
      • Chronic Lymphangitis
      • Filariasis

     

    Approach to Generalized Edema

    • Increased Hydrostatic Pressure / Fluid Overload
      • Heart Failure
      • Pregnancy
      • Drugs (e.g. CCB)
      • Iatrogenic (e.g. IV fluids)
    • Decreased Oncotic Pressure / Hypoalbuminemia
      • Nephrotic Syndrome   (Removed by kidneys)
      • Liver Cirrhosis   (Not made)
      • Malnutrition    (Not enough protein to build)
    • Increased Capillary Permeability
      • Severe Sepsis
    • Hormonal
      • Hypothyroidism
      • Exogenous Steroids
      • Pregnancy
      • Estrogens

     

    Approach to Syncope

    • 1. Hypovolemia
    • 2. Cardiac
      • Structural / Obstructive
        • LV Dysfunction
          • ACS
          • Aortic Stenosis
          • Hypertrophic Cardiomyopathy
        • Outside the Heart
          • Cardiac Tamponade
          • Constrictive Pericarditis
      • Arrhythmias (AV block, sinus node dysfunction, AFib w/ tachy/bradycardia, SVT or VT).
    • Respiratory
      • Massive Pulmonary Embolus
      • Pulmonary HTN, Hypoxia, Hypercapnia
    • Neurologic
      • Stroke/TIA  (vertebrobasilar insufficiency)
      • Migraine
      • Seizure
      • Autonomic Dysfunction
        • Diabetic neuropathy
    • Metabolic
      • Anemia
      • Hypoglycemia
    • Drugs
      • Antihypertensives
      • Antiarrhythmics
      • Diuretics
    • Vasovagal
    • Psychiatric
      • Panic Attack

     

    Approach to Dyspnea

    • Cardiac
      • Structural
        • Acute MI
        • CHF/LV Failure
        • Valvular
          • Aortic/Mitral Regurg
          • Aortic/Mitral Stenosis
        • L-sided obstructive lesions (I.e. L atrial myxoma)
      • Arrhythmia
      • Outside the heart
        • Cardiac Tamponade
        • Constrictive Pericarditis
      • Respiratory
        • Airway Disease
          • Asthma
          • COPD Exacerbation
          • Upper airway obstruction (anaphylaxis, foreign body, mucous plug)
        • Parenchymal Lung Disease
          • ARDS
          • Pneumnia
          • ILD
        • Pulmonary Vascular Disease
          • PE
          • Pulmonary HTN
          • Pulmonary Vasculitis
        • Pleural Disease
          • Pneumothorax
          • Pleural Effusion
      • Neuromuscular and chest wall disorders
        • C-spine injury
        • Polymyositis, myesthenia gravis, Guillain-Barre Syndrome
        • Kyphoscoliosis
      • Psych - Anxiety
      • Hematologic/Metabolic
        • Anemia
        • Acidosis
        • Hypercapnia

     

    Weight Loss

    • Requires 3:
      • Diet
      • Physical Activity
      • Behavioral Therapy
    • Indications for bariatric Surgery:
      • BMI >=40
        OR
      • BMI >= 35 with obesity-related comorbid conditions
    • Indications for pharmacological agents (Orlistat or phentermine - IN USA)
      • Patients on diet, physical activity, and behavioral therapy + BMI >= 30
        OR
      • BMI >= 27 with overweight or obesity-associated comorbidities
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